Burden and risk factors for coronavirus infections in infants in rural Nepal

S. M.Iftekhar Uddin, Janet A. Englund, Jane Y. Kuypers, Helen Y. Chu, Mark C. Steinhoff, Subarna K. Khatry, Steve C. Leclerq, James M. Tielsch, Luke C. Mullany, Laxman Shrestha, Joanne Katz

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background Knowledge of risk factors for symptomatic human coronavirus (HCoV) infections in children in community settings is limited. We estimated the disease burden and impact of birth-related, maternal, household, and seasonal factors on HCoV infections among children from birth to 6 months old in rural Nepal. Methods Prospective, active, weekly surveillance for acute respiratory infections (ARIs) was conducted in infants over a period of 3 years during 2 consecutive, population-based randomized trials of maternal influenza immunization. Midnasal swabs were collected for acute respiratory symptoms and tested for HCoV and other viruses by reverse-transcription polymerase chain reaction. Association between HCoV incidence and potential risk factors was modeled using Poisson regression. Results Overall, 282 of 3505 (8%) infants experienced an HCoV ARI within the first 6 months of life. HCoV incidence overall was 255.6 (95% confidence interval [CI], 227.3-286.5) per 1000 person-years, and was more than twice as high among nonneonates than among neonates (incidence rate ratio [IRR], 2.53; 95% CI, 1.52-4.21). HCoV ARI incidence was also positively associated with the number of children <5 years of age per room in a household (IRR, 1.13; 95% CI, 1.01-1.28). Of the 296 HCoV infections detected, 46% were coinfections with other respiratory viruses. While HCoVs were detected throughout the study period, seasonal variation was also observed, with incidence peaking in 2 winters (December-February) and 1 autumn (September-November). Conclusions HCoV is associated with a substantial proportion of illnesses among young infants in rural Nepal. There is an increased risk of HCoV infection beyond the first month of life.

Original languageEnglish (US)
Pages (from-to)1507-1514
Number of pages8
JournalClinical Infectious Diseases
Issue number10
StatePublished - Oct 30 2018


  • acute respiratory infection
  • coronavirus
  • epidemiology
  • infants
  • respiratory virus

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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